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Incidental cardiac uptake of 99mTc-diphosphonates is predictive of poor outcome: data from 9616 bone scintigraphies
A Salvalaggio1,2, A Cipriani3, S Righetto1
1Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy.
Insights
Cardiac uptake on bone scintigraphy (BS) is a rare finding suggesting transthyretin amyloid cardiomyopathy (ATTR). This cardiac uptake is associated with increased mortality, highlighting the need for physician awareness for timely diagnosis and treatment.
Area of Science:
- Nuclear medicine
- Cardiology
- Amyloidosis
Background:
- Bone scintigraphy (BS) is a key diagnostic tool for transthyretin amyloid (ATTR) cardiomyopathy.
- The prevalence and prognostic implications of cardiac uptake on BS are not well-defined.
- This study investigates subclinical cardiac ATTR amyloidosis in patients undergoing scintigraphy.
Purpose of the Study:
- To determine the prevalence of subclinical cardiac ATTR amyloidosis in patients undergoing [99mTc]MDP/DPD scintigraphy.
- To characterize the phenotype of these patients.
- To evaluate the prognostic impact of cardiac uptake on survival.
Main Methods:
- Retrospective review of 9616 BS scans performed between 2009 and 2020.
- Stratification of patients based on the Perugini visual score for cardiac uptake.
- Collection of follow-up data to assess patient outcomes.
Main Results:
- Cardiac uptake was observed in 0.7% (n=67) of BS scans.
- A Perugini score ≥ 2, indicative of cardiac ATTR amyloidosis, was present in 30% of these patients.
- Patients with a Perugini score ≥ 2 had a significantly higher mortality rate (P = .018) compared to those with a score of 1.
Conclusions:
- Cardiac uptake on BS, suggestive of ATTR amyloidosis, is a rare but significant finding.
- This finding negatively impacts patient survival and may be overlooked, delaying diagnosis.
- Physicians should recognize this finding for prompt diagnosis and management of ATTR cardiomyopathy.
Background:
Bone scintigraphy (BS) is highly diagnostic for amyloid transthyretin (ATTR) cardiomyopathy. Prevalence and prognostic value of BS cardiac uptake is not well established. Our aim was to assess the prevalence of subclinical cardiac ATTR amyloidosis in patients undergoing [99mTc]MDP/DPD scintigraphy and to define their phenotype and prognosis.
Methods And Results:
BS scans performed for any clinical indications from 2009 to 2020 were reviewed. Patients were stratified according to Perugini visual score of cardiac uptake. Follow-up data were collected. Among 9616 BS scans, 0.7% (n = 67) showed cardiac uptake. In 47 (70%) patients, Perugini score was 1 and in 20 (30%) patients uptake was ≥ 2, suggesting cardiac ATTR amyloidosis. Forty subjects (61%) died during the follow-up (mean 47 ± 30 months). Compared with patients with Perugini score 1, those Perugini score ≥ 2 showed increased death rate (P = .018). Two (2/67) subjects were investigated for TTR gene mutations resulting negative.
Conclusions:
In patients undergoing BS for different clinical indications, cardiac uptake suggesting cardiac ATTR amyloidosis is a rare, but still neglected finding, thus preventing possible diagnosis of ATTR cardiomyopathy. Importantly, cardiac uptake negatively affects the survival. Physicians should be aware of this rare, but crucial finding for timely diagnosis and treatment.
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